I think it's very fair (and as you know as an epidemiologist, correct) to differentiate between a country's public health system and medical system. And between

I think it's very fair (and as you know as an epidemiologist, correct) to differentiate between a country's public health system and medical system. And between a country's primary, secondary, and tertiary medical care systems. It's true that SA has quite good tertiary and secondary care, while they struggle with public health and primary care. I do think the pricing mechanism of almost any other country outside the US is more reasonable than ours. Insurance, big hospital chains, and yes, to a lesser extent the AMA, have ripped pricing from its market mooring. There are many other countries that have well-functioning market-based medical systems (even as they sometimes struggle with public health system due to poverty): Mexico and India spring to mind. Even catastrophic medical care (eg, cancer treatment, or major trauma) is affordable to the middle class in both of those countries, unlike in the US, where those events can ruin a middle class family even with insurance (I've lived it myself, to some extent). Regulation can play a positive role here, but not by creating more bureaucracies. Rather, we need more transparent pricing. We need enforcement of anti-trust legislation against big hospital chains. With some hesitation, I'd say we also need to resume of significant prior support of basic medical research to push big pharma beyond their current biosimilars business model. And we need to "encourage" the AMA to put out more physicians (the student loan issue can be mostly solved by getting the government out of the student loan game).